Table 1 Laboratory tests included in the differential diagnosis of the pulmonary nodular lesion

Inflammatory markers

White blood count 10,61 G/l, lymphocytic predominance in differential (57 %)

C-reactive protein (CRP) increased 2,46 mg/dl

Biochemistry

Serum activity of amylase 23 IU/l, lipase 3 IU/l, aminotransferases normal

Infections

Specific serum IgM and IgG antibodies against Mycoplasma pneumoniae, Toxoplasma gondii, hepatitis B and C viruses (HBV, HCV), cytomegalovirus (CMV) negative

Epstein-Barr virus (EBV)-DNA in blood positive (1400 copies/ml)

Galactomannan (Aspergillus antigen) in serum negative

QuantiFERON TB negative

Sputum culture: Staphylococcus aureus MSSA

Neoplastic markers

Serum alpha-fetoprotein (AFP) 1,1 ng/ml, carcinoembryonic antigen (CEA) 0,24 ng/ml, beta-human chorionic gonadotropin (β-HCG) <2,39 mIU/ml not elevated

Secretion of catecholamines in 24-hour urine collection normal: vanillylmandelic acid (VMA) 7,3 mg/24 hrs, dopamine 190,6 mcg/24 hrs

Allergy

Total serum IgE elevated 660 kU/l

Allergen-specific IgE against airborn and food allergens: horse 0,7 kU/l (1 class), wormwood 0,7 kU/l (1 class)

Immunology

Serum immunoglobulin (Ig) G and M normal (989 and 86 mg/dl, respectively), IgA increased 197 mg/dl

Complement in serum normal C3 135 mg/dl, C4 23 mg/dl

IgG subclasses normal: IgG1 617,90 mg/dl, IgG2 237,20 mg/dl, IgG3 54,87 mg/dl, IgG4 42,16 mg/dl

Flow cytometric peripheral blood immunophenotyping: lymphocytes 5300 cells (50 %), increased absolute count and relative value of CD8+ T cells (2760 cells/mm3, 50 %) and decreased of CD4+ T cells (718 cells/mm3, 13 %),

defective B-cell maturation: decrease of the absolute count and relative value of switched memory CD19 + CD27 + sIgD- B cells (39 cells/mm3, 7,9 %) and of non-switched memory CD19 + CD27 + sIgD+ B cells (14 cells/mm3, 2,9 %), plasmablasts CD19 + CD38hisIgM- normal (13 cells/mm3, 2,6 %)

Autoimmunization

ANA antibodies against nRNP/Sm, Sm, SS-A, SS-B, Ro-52, Scl-70, PM-Scl, Jo-1, CENP B, PCNA, AMA M2, dsDNA, nucleosomes, histones, ribosomal protein P negative

ANCA antibodies against protease-3, myeloperoxidase, elastase, lactoferrin, catepsin G, BPI negative